- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,480.71 / $2,822.00 / $6,075.00
| Facility | | $1,480.71 | $2,822.00 | $6,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,222.86 / $1,480.71 / $3,018.42
| Professional | | $1,222.86 | $1,480.71 | $3,018.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,939.00 / $6,280.00 / $16,742.00
| Facility | | $1,939.00 | $6,280.00 | $16,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.40 / $2,881.47 / $10,701.68
| Professional | | $1,288.40 | $2,881.47 | $10,701.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.96 / $1,832.72 / $3,239.04
| Facility | | $1,411.96 | $1,832.72 | $3,239.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,726.90 / $2,893.50 / $5,562.27
| Professional | | $1,726.90 | $2,893.50 | $5,562.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,199.82 / $1,930.92 / $6,679.00
| Facility | | $1,199.82 | $1,930.92 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.61 / $2,141.33 / $3,790.15
| Professional | | $1,694.61 | $2,141.33 | $3,790.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.31 / $3,171.26 / $4,048.44
| Professional | | $1,530.31 | $3,171.26 | $4,048.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,739.37 / $1,739.37 / $1,826.34
| Professional | | $1,739.37 | $1,739.37 | $1,826.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $7,250.00 / $26,542.00
| Facility | | $2,324.00 | $7,250.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,823.24 / $4,362.91 / $10,701.68
| Professional | | $1,823.24 | $4,362.91 | $10,701.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $5,097.00 / $10,764.00
| Facility | | $2,324.00 | $5,097.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,690.89 / $2,325.34 / $5,655.91
| Professional | | $1,690.89 | $2,325.34 | $5,655.91 |